Sunburn and Keytruda: Two reasons to cover up – And I’m not talking about clothing

I had a string of overseas visitors staying with me over the summer. So, being the host with the most, I gave them plenty of advice on what’s what in magnificent Wellington. Stay away from this terrible bar on Courtenay Place . . . And this terrible bar on Courtenay Place . . . and this terrible–actually, just stay away from Courtenay Place altogether. Avoid cruddy Starbucks when there are so many other top-shelf coffee shops. Don’t bother attempting to use umbrellas in the wind, you know, that kind of thing. Now, as important as those tidbits are, I noted that I was warning guests about one thing in particular: Sunburn. Yes, my number one piece of advice was a health and safety message. To my surprise, I repeatedly warned people about the ten-minute burn time we get at the top of the day in the height of summer.

“Sunburn in ten minutes? Surely not,” my guests would scoff in a heavy French accent.

“I kid you not, mon frère, make sure you le slip, le slop, le slap.” And the next time I see them they’re the colour of beetroot.

New Zealand is dangerous in the summer, and Kiwi kids are brought up to be “SunSmart.” They’re taught to wear hats, use sunscreen, stay covered and seek the shade as much as possible . . . Actually, what am I talking about, those campaigns aren’t just targeting children; they’re intended to educate adults too! Such is the scale of our problem. I mean, you can get sunburned anywhere in the world but seldom in ten minutes. So what am I really on about here? Ten-minute burn times matter because of the long-term risks posed to your health when you roast and repeat. That’s right: MELANOMA.

‘Sunburn in ten minutes? Surely not,” my guests would scoff in a heavy French accent.

Sadly, none of this is anecdotal or simply just scaremongering. QIMR Berghofer Medical Research Institute recently published a piece in The Journal of Investigative Dermatology asserting that New Zealand now has the greatest rate of skin cancer in the world taking the place from the previous record holder Australia. Yay, we’re number one! We’re number… one. Oh, wait, so I guess it’s not always good to beat Australia at everything. The study indicated that New Zealand has a melanoma rate of 50 cases per 100,000 people. Ouch.

This rate has become problematic in New Zealand because of the difficulties with treatment of advanced melanoma. When I say difficulties, however, I mean access to treatment. One new drug in particular, Keytruda, or as I prefer to call it, Pembrolizumab, has been generating a lot of discussion in the media, much of it divisive.

Keytruda is a melanoma immunotherapy treatment that is not currently subsidised by Pharmac. Although it is being investigated, the drug that was named 2013 scientific breakthrough of the year has been given a low priority, much to the ire of many. So, although they haven’t said a point-blank no to Keytruda, the process is dragging, especially for Tom, Dick and Harriet, who would potentially benefit from treatment but can’t pay for it.

Why the difficulty, though? It simply comes down to cost. One 50mg vial of Keytruda is NZD$2360.00. Oh well, that’s not too expensive, is it? Just max out your credit card… What’s that, you need a belt of the stuff every three weeks? Oh, I see the problem. Naturally, costs for treatment can get up into the $100,000s over the course of a year once you include clinic time, courier, dispensing fees, administration fees, the list goes on. Any patients who can’t afford Keytruda must instead use Dacarbazine (chemotherapy), which unfortunately is not known for its efficacy with melanoma and works approximately 10% of the time.

Keytruda is an immunological treatment that works, well, a little bit like someone who cheats at hide and seek, if you ask me. Essentially, cancer cells can hide in something called your PD-1 pathways where your cancer fighting T-cells can’t find them. Keytruda blocks those pathways, meaning the filthy cancer can’t hide and your heroic T-cells can throw down the gauntlet and do valiant battle. Go science!

But, of course, all that means nothing if you can’t get the treatment in the first place, and thus, we’ve come full circle. This is also why we’re seeing more and more instances of terminal patients turning to options like Givealittle in an attempt to cover medical costs. Givealittle is a fantastic wealth redistribution tool, and, of the 19.7 million dollars donated through the website in 2015, one in every five dollars was going towards health and associated treatments.

It’s no secret that New Zealanders are woefully uninsured, and, in fact, are one of the lowest in the OED, but, what we’ve really got here is 3.8 million dollars in 2015 that wasn’t covered by insurance. To me, these Givealittle pages are compensating for a lack of personal insurance. The only quasi-criticism one could level is that it’s a shame these patients need to have finance as a stressor at a time when energies could be better spent focusing on treatment rather than accounting.

But, would insurance help these terminal patients with invasive melanoma? Absolutely... but also, um, perhaps.  I say perhaps because some health insurance policies don’t cover non-Pharmac drugs and that is way it pays to check your coverage.

So, in a nutshell, in an underinsured society, a condition that occurs at the highest rate in the world and kills more than 300 New Zealanders a year is very difficult to get treated, sometimes even with an insurance policy. Not ideal.

So, what can you do? I’m afraid the old common sense slip, slop, slap only gets you so far and another form of cover could be needed. Let’s have a look at a few of the ways you can keep you and your family safe so you receive the best treatment your money can’t buy should invasive melanoma strike.

  1. Be excessively wealthy. This is the best option, I suppose. Get yourself sick? No worries, get out the chequebook and pay for the best treatment available without ever having to get out of your money bath. Done. Sweet deal.

  2. Health insurance. Yep, plain old health insurance. If you don’t have health insurance, this is step number one. Look into it. If you insure your car, your house, your pet, or your phone, but not your body, have a think about that for a moment and consider the implications. If you are currently covered by health insurance, you should double-check your policy to see if you’re covered for non-Pharmac drug treatments. If you’re not, by paying a slightly increased premium, you can ensure that regardless of what treatment you need you will be covered.

  3. Trauma insurance. Although this isn’t going to cover and specifically pay for drug treatments such as Keytruda, trauma policies include a lump sum payment for serious conditions. For example, if you’re diagnosed with some kind of terminal cancer – heaven forbid – you would get a lump sum payment of a pre-agreed sum, say $200,000, that you could then choose to put towards treatment (or any other pressing need). This kind of policy coupled with income protection, or health insurance, would mean you and your family can focus solely on battling the illness rather than the stress and worry of paying for treatment.

So, there you go. Melanoma is scary and possibly one of the biggest challenges an individual can face, but this battle is transformed into tragedy when there is a form of treatment there and available but out of reach because of finances. There are always going to be drugs that are not covered by Pharmac so consider your options now to secure your future.

Samuel Rees-Thomas